The Centers for Disease Control and Prevention now recommends routine (non-targeted) HIV testing in all health care settings, including hospital emergency departments (EDs) and urgent care clinics (UCCs). HIV diagnoses from acute care settings represent a key target population for treatment and prevention efforts, especially since medical HIV testing initiatives often serve vulnerable urban groups who have been shown to be at increased risk for failing to engage in care. However, an estimated 30-50% of new HIV diagnoses in the U.S. fail to enter care within 6 months. Few studies exist on how to rapidly and fully engage recently diagnosed HIV patients in care. Moreover, little is known about how being diagnosed via routine (non-targeted) testing impacts retention in the first months of care. The goals of this proposal are to generate knowledge about the determinants of rapid and full engagement in HIV care and develop strategies to promote it. This research is guided by a conceptual- theoretical model that informs measurement instruments and a structured research plan. For patients diagnosed with HIV via routine (non-targeted) testing in the San Francisco General Hospital ED/UCC and who establish care in the SFGH HIV clinic, specific aims are to: 1) Identify barriers to and facilitators of rapid full engagement in care; 2) Determine predictors of rapid full engagement in HIV care; 3) Develop an intervention to promote rapid full engagement in HIV care. Specific Aim 1 will be accomplished via qualitative methods. Specific Aim 2 will be accomplished through baseline assessment of socio-demographic, behavioral, and clinical variables and use of the electronic medical record to track appointment and clinical outcomes. Specific Aim 3 will be accomplished through analysis of data from Aims 1 & 2, a literature review of related fields, and stakeholder input. Through a focused program of coursework and mentored training, the candidate will develop the skills in qualitative inquiry, cohort-based epidemiologic approaches, behavioral theory and intervention development to execute these specific aims and lay the foundation to become an independent investigator dedicated to closing the gap between HIV case identification and care initiation. PUBLIC HEALTH RELEVANCE: HIV screening in the U.S. has expanded to acute medical settings, such as emergency departments and urgent care clinics, where patients are offered testing regardless of the reason for the visit. Little is known about how patients newly diagnosed with HIV in acute medical settings establish outpatient HIV care. This research will help identify key factors in rapid and full engagement in HIV care and develop an intervention to support this process.